Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.
Background:
Understanding factors causing variation in family physicians/general practitioners (GPs) screening knowledge, understanding and support of organised population-based colorectal cancer (CRC) programs can direct interventions that maximise the influence of a CRC screening recommendation from a GP. This study aims to assess contextual factors that influence knowledge and quality improvement (QI) practice directed to CRC screening in Australian general practice.
Methods:
A convenience sample of anonymous general practice staff from all Australian states and territories completed a web-based survey. Multivariate analyses assessed the association between CRC screening knowledge and QI-CRC practice scores and patient, organisational and environmental-level contextual factors.
Results:
Of 1,013 survey starts, 918 respondents (90.6%) completed the survey. Respondents less likely to recommend FOBT screening had lower knowledge and QI practice scores directed to CRC screening. Controlling for individual and practice characteristics, respondents’ rating of the Australian National Bowel Cancer Screening Program (NBCSP) support for preventive care, attending external education, and sufficient practice resources to implement QI practice (generally) were the strongest factors associated with QI practice directed towards CRC screening. Knowledge scores were less amenable to the influence of contextual factors explored.
Conclusion:
More active engagement of family medicine/general practice to improve screening promotion could be achieved through better QI resourcing without changing the fundamental design of population-based CRC screening programs.
Issue addressed
Consumption of energy drinks is a public health concern, particularly in adolescents and young adults. This study explored energy drink consumers' reactions to an energy drink‐specific warning label (risk of cardiac effects) and a more general sugary drink warning label (risk of obesity).
Methods
An online experimental study randomly allocated Australian energy drink consumers aged 18‐39 years (N = 435) to view one of two label conditions (cardiac effects or obesity). Participants were assessed on: intention to reduce energy drink consumption, perceived health threat, perceived label effectiveness and policy support for energy drink warning labels.
Results
Mean intentions to reduce consumption scores were similar across the two label conditions (Mobesity = 2.5, Mcardiac = 2.6) overall; and were higher for the cardiac label (compared to obesity label) for some subgroups: females (Mobesity = 2.3, Mcardiac = 2.8; p = .037), older (25‐39 years; Mobesity = 2.4, Mcardiac = 2.8; p = .016); and higher education level (Mobesity = 1.9, Mcardiac = 2.7; p = .004). While perceived health threat measures were higher for obesity than cardiac effects, perceived label effectiveness measures of ‘believable’ and ‘relevant to me’ were higher for the cardiac label than the obesity label (believable: 71.0% vs 56.1%; relevant: 42.5% vs 29.4%). Participants who viewed the cardiac label were more likely to support policy than those shown the obesity label (OR = 1.6, 95%CI [1.1, 2.3], p = .02).
Conclusions
Health effect warnings labels were perceived by energy drink consumers to be impactful and are supported. Labels with energy drink‐specific health effects may offer additional benefit.
So what?
Policy makers can feel confident that warning labels on energy drinks will confer public health benefit.
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